Provider Demographics
NPI:1518315662
Name:BOWEN, AMANDA (MPH, RD, CDE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 11TH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3520
Mailing Address - Country:US
Mailing Address - Phone:909-615-2171
Mailing Address - Fax:
Practice Address - Street 1:511 11TH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3520
Practice Address - Country:US
Practice Address - Phone:909-615-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1059335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered